Percutaneous coronary intervention

2020 ◽  
pp. 183-252
Author(s):  
Andrew Mitchell ◽  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Optical Coherence Tomography ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Percutaneous Coronary Intervention Procedure ◽  
Percutaneous Coronary ◽  
History Of ◽  
Drug Eluting ◽  
Intervention Procedure

This chapter covers percutaneous coronary intervention. It starts with the history of the procedure, indications, and techniques for imaging the lesion, and describes different systems of lesion classification. The equipment required for percutaneous coronary intervention, including guiding catheters, angioplasty guide wires, angioplasty balloons, and intracoronary stents (drug-eluting stents, bioabsorbable scaffolds, etc.) are all covered. The percutaneous coronary intervention procedure is then explained. Intravascular ultrasound is compared and contrasted to optical coherence tomography. Antiplatelet and anticoagulant therapies are described in detail, and finally specific techniques in complex PCI are covered.

Percutaneous Coronary Intervention for Complex Bifurcation Lesions

2010 ◽  
Vol 5 (1) ◽  
pp. 58
Author(s):  
Yves Louvard ◽  
Morice Marie-Claude ◽  
Thomas Hovasse ◽  
Thierry Lefèvre ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Drug Eluting Stents ◽  
Open Angle ◽  
Balloon Inflation ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Stent Diameter

Coronary bifurcations are prone to the development of atherosclerosis. They pose technical difficulties for angioplasty treatment and are a predictor of stent thrombosis and restenosis. Treatment of coronary bifurcations is still subject to debate, especially when the side branch (SB) is large, not easily accessible and narrowed by a long lesion. There is currently no indexed treatment for this type of lesion (Medina classification), as the strategy of provisional SB stenting with drug-eluting stents (DES) has proved to be equally efficient as the dualstent technique. Complex techniques are associated with poor outcome in certain lesion types, such as T-stenting when the angle between the two distal branches is small or the crush and culotte technique in the presence of an open angle. Provisional SB stenting may be used when primary dual stenting is required, with a low risk of failure provided that the following guidelines are implemented: stenting of the main branch through the protected SB with a stent diameter adapted to the distal main branch, immediate optimisation of the proximal stent segment (Finet’s law), guidewire exchange, kissing balloon inflation with non-compliant balloons selected according to the diameter of the distal branches and T-stenting of the SB before final kissing inflation.

scholarly journals The role of optical coherence tomography guidance in scaffold versus stent optimization

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Arif A. Al Nooryani ◽  
Nagwa A. Abdelrahman ◽  
Hatem A. Helmy ◽  
Yehia T. Kishk ◽  
Ayman K. M. Hassan
Keyword(s):  
Decision Making ◽  
Optical Coherence Tomography ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Total Rate ◽  
Great Ability ◽  
Bioresorbable Scaffolds ◽  
Drug Eluting ◽  
The Impact

Abstract Background Optical coherence tomography showed a great ability to identify adverse features during percutaneous coronary intervention with drug-eluting stents and resulted in better clinical outcomes. The study aimed to assess the impact of optical coherence tomography on intraoperative decision-making during implantation of Absorb bioresorbable scaffolds versus everolimus drug-eluting stents. Results We performed an observational study that included 223 consecutive patients post optical coherence tomography-guided implantation of either Absorb bioresorbable scaffolds (162 patients) or everolimus drug-eluting stents (61 patients). We studied the influence of optical coherence tomography on intraoperative decision-making during implantation of bioresorbable scaffolds versus drug-eluting stents by analyzing the total rate of optical coherence tomography-dependent modifications in each device. After satisfactory angiographic results, the total rate of required intervention for optical coherence tomography detected complications was significantly higher in the bioresorbable scaffolds arm compared to drug-eluting stents arm (47.8% versus 32.9%, respectively; p = 0.019). The additional modifications encompassed further optimization in the case of device underexpansion or struts malapposition, and even stenting in the case of strut fractures, or significant edge dissection. Conclusions Compared to drug-eluting stents, Absord scaffold was associated with a significantly higher rate of optical coherence tomography-identified intraprocedural complications necessitating further modifications. The study provides some hints on the reasons of scaffolds failure in current PCI practice; it offers a new insight for the enhancement of BRS safety and presents and adds to the growing literature for successful BRS utilization.

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